Prognostic Value of Interim [F]FDG PET/CT After Immunotherapy-based Combinations in Extranodal NK/T-cell Lymphoma, Nasal Type

Overview

Journal Eur Radiol

Date 2025 Jan 21

PMID 39836202

Authors

Lei Liu

Shihui Hao

Wanqi Chen

Ming Jing

Shatong Li

Weiguang Zhang

Liping Liang

Fan Wei

Yujing Zhang

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the prognostic value of interim [F]Fluorodeoxyglucose positron emission tomography/computed tomography ([F]FDG PET/CT) after immunotherapy-based systemic therapies in extranodal natural killer/T-cell lymphoma (ENKTL).

Patients And Methods: We retrospectively recruited 133 newly diagnosed nasal-type ENKTL patients who underwent interim [F]FDG PET/CT scans after 2-4 cycles of immunotherapy-based treatments. Interim PET/CT was interpreted by maximum standardized uptake value (SUV), Deauville 5-point scale (DS), and early treatment response. The prognostic value of overall survival (OS) and progression-free survival (PFS) was assessed with survival curves generated using Kaplan-Meier analysis and compared using the log-rank test. Univariate and multivariate Cox proportional hazards analyses were performed to evaluate the independent effects for survival. Model performance was assessed with a time-dependent area under the curve (time-AUC), concordance index (C-index), and the Akaike information criterion (AIC).

Results: Patients with high SUV (> 9.2), DS 5, or with stable disease (SD) or relapsed/progressive disease (PD) on interim PET/CT showed significantly unfavorable OS and PFS with the Kaplan-Meier estimate, respectively. The interim PET/CT parameters remained independent predictors for both OS and PFS after univariate and multivariate analysis. We combined interim DS with the prognostic index for natural killer cell lymphoma-Epstein-Barr virus (PINK-E) model to stratify our cohort into 3 risk categories: low-risk (0-2 risk factors), intermediate-risk (3 risk factors), and high-risk (≥ 4 risk factors), which showed significant and superior stratifications of OS and PFS than PINK-E.

Conclusion: Interim PET/CT after immunotherapy-based systemic treatments showed independent prognostic value for ENKTL. The model combining interim PET/CT with PINK-E might be an effective prognostic tool.

Key Points: Question The prognostic value of interim [F]FDG PET/CT in extranodal natural killer/T-cell lymphoma remains uncertain, especially after the introduction of immunotherapy. Findings Deauville 5-point scale on interim [F]FDG PET/CT after immunotherapy-based systemic therapies was an independent predictor for newly diagnosed extranodal natural killer/T-cell lymphomas. Clinical relevance Interim [F]FDG PET/CT alone or combined with the prognostic index for natural killer cell lymphoma-Epstein-Barr virus (PINK-E) model is an effective and superior prognostic tool for clinical application in the era of immunotherapy.

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